The aim of this project is to inform the doctor about the ICU patient condition through wireless. For the medical professionals it becomes important to continuously monitor the conditions of a patient. In a large setup like a hospital or clinical center where a single doctor attends many patients, it becomes difficult to keep informed about the critical conditions developed in each of the patients. This project provides a device which will continuously monitor the vital parameters to be monitored for a patient and do data logging continuously. If any critical situation arises in a patient, this unit also raises an alarm and also communicates to the concerned doctor by means of an SMS to the doctor.
We formed a multidisciplinary team made up of nurses, respiratory therapists, neonatal and other subspecialty physicians, and NICU leaders. By using process flow diagrams, results from root cause analyses, qualitative feedback, and baseline data, we developed a 3-stage intervention to target modifiable key drivers of AEs (Supplemental Fig 3). These key drivers were preprocedural preparation, equipment and medication availability, patient- specific situational awareness, team communication, and adequate sedation and neuromuscular blockade for intubation. Our interventions were sequentially implemented and refined according to the Institute for Healthcare Improvement’s Model for Improvement in a series of plan–do–study–act cycles, 8 as
Although the association between sleep disturbances and ICU delirium has not been studied, sleep deprivation impairs cognition  and the relationship between sleep during critical illness and delirium is a promising area of ongoing research. On average, ICU patients sleep only 2 hours per day , and less than 6% of their sleep is random eye movement sleep. Cooper and coworkers  studied 20 mechanically ventilated ICU patients using polysomnography and observed that every patient had severely disrupted sleep or none at all. Such disturbances may detrimentally affect protein synthesis, cellular and humoral immunity, and energy expenditure, and ultimately they may contribute to organ dysfunction such as delirium. Excessive noise and patientcare activities account for only a minority of arousals in ICU patients, whereas metabolic derangements, mechanical ventilation, and exposure to sedative and analgesic medica- tions probably play significant roles in disturbing sleep in the ICU . Because sedative and analgesic medications may lead directly to delirium or may contribute to impaired Table 1
One of the hallmarks of the metabolic response to injury is catabolism (negative nitrogen balance). There is acceler- ated proteolysis of skeletal muscle, which provides some of the substrate for increased hepatic gluconeogenesis. Reducing the rate of hepatic gluconeogenesis with somatostatin does not decrease the rate of peripheral protein breakdown, demonstrating that the accelerated rated of hepatic glucose production is not linked to the elevated level of peripheral protein breakdown . The degree of nitrogen loss is proportional to the degree of stress, and abates as the patient convalesces . The increased protein breakdown is thought to be modulated only partly by the endocrine stress hormones, such as cor- tisol . Instead, other mediators such as the cytokines TNF- α , IL-1, IL-6 and interferon- γ are involved in medi- ating catabolic activity. It is the balance between these catabolic hormones and anabolic hormones such as insulin and insulin-like growth factors that determine the degree of catabolism. A number of metabolic pathways may be responsible for skeletal muscle proteolysis, including the
They way work is interrupted by the patient and the effect it has on their psychological well-being is called sentimental work, as it the effect it has on the patient which is central to this type of work. It is present in any work in which the patient is conscious and responding (Strauss, Fagerhaugh, Suczek, & Wiener, 1982a; Strauss et al., 1985). For example, a fundamental skill such as a nurse giving a patient a bed bath is not sentimental work, but how the nurse makes the patient feel while she is giving them a bed bath is sentimental work. Strauss argues there are many influencing factors that make this work complex and difficult. Firstly, this work is carried out by people, healthcare professionals, who do not know the biography of the patient. Therefore, a patient being given a bed bath by a stranger who is not sensitive to their individual needs may potentially affect the patients’ well-being. Secondly, the medical aspects of the work take priority, hence, strangers focus on the medical aspect of work and not the patient. Thirdly, sentimental work is often invisible to healthcare professionals performing this work and to bystanders, as the nurse may not know how she made the patient feel while giving them a bed bath (Fagerhaugh et al., 1987; Strauss et al., 1982a). Fourthly, the duration of this work is cumulative to the patient, so if the nurse does this task efficiently according the patient’s needs it will have less of an impact. Finally, the amount of sentimental work also required by the patient, because of their dependency, has an cumulative effect. A patient who has become totally dependent for a prolonged period of time and has to endure many bed baths of varying levels of comfort will experience an accumulative effect on their well-being. Hence, the long- term intensivecarepatient will endure prolonged sentimental work due to their level of dependence over a period of time.
During the baseline (preincentive) period, only one of the six ICUs averaged documenting 75% patient-care time (range, 20% to 75%; Table 1). It is important to note that the only way to document time in the baseline period was by billing for patient-care activities. Time that was not billed could have been either (a) patientcare-related but not billable (time spent rounding, training other pro- viders in procedures, and sign out), or (b) not patient- care related. No mechanism was in place, however, to determine how much time was dedicated to each of these. The average amount of patient-care time billed was 53% (individual range, 21% to 95%), meaning that at baseline, it was unclear what activities affiliates were engaged in for nearly half of their paid time in the hospi- tal. Even in the ICU that averaged 75% in aggregate, sev- eral individual affiliates billed for less than 75% of their time. Only six of 32 affiliates billed for 75% of their time
Admission into an intensivecareunit (ICU) is associated with short and long-term physical impairment, cognitive deterioration, and emotional consequences for patients and their relatives [1–4]. Less than 10% of patients who were mechanically ventilated for more than four days are alive and fully independent one year later . In addition to the challenges of recovering from both an underlying disease and physical revalidation, emotional distress post ICU admission needs to be addressed. From USA studies, it is known that 12% to 43% of recovering ICU patients still suffer from some form of anxiety (including paranoia, nightmares, and hallucinations), depression (10 to 30%), or even post-traumatic stress (10% to 64%) [6–8]. In South-Africa, one study showed 58% anxiety, 28% depres- sion, and 32% of post-traumatic stress in post ICU patients . A Chinese study reported a high incidence rate of anxiety (59.7%) in ICU patients’ family members who acted as representatives of the patient, and concluded that nurses should pay more attention to the family mem- bers and provide more psychological nursing when taking care of patients . Recently, a Post IntensiveCare Syndrome (PICS) has been defined to underscore the total impact of an ICU admission: “The new or worsening im- pairments in health status arising and the persistence after hospitalization for a critical illness ” [5, 11]. These continu- ing problems could weigh heavily on national healthcare costs and need to be addressed by healthcare professionals . Therefore, the care of critically ill patients does not end upon ICU discharge . Transition of care is associ- ated to medical errors , the risk for readmission , morbidity , and increased mortality . Thus, inte- grated and ongoing care post-ICU discharge is pivotal to reduce the emotional impact of ICU admission.
From the results of the analysis, it was found that there is an effect of the application of controlling in the nursing care management to the VAP bundles in the intervention group. This is in line with the research implementation of VAP prevention and control in the ICU room refers to the Ministry of Health regulation number 27/2017 with several innovations and adjustments . Communication related to the implementation of the VAP bundle in the ICU room went well; nurses were given the
This is a prospective study which was conducted over a 6‑month period (from December 2014 to May 2015) in the ICU of the “G. Hatzikosta” General State Hospital of Ioannina, Northwest Greece. This is a six‑bed ward which provides care for all critically ill patients. All family members of patients admitted to the ICU for at least 1 week were eligible for participation. Exclusion criteria were age <16 years, non‑Greek speaking, and current mental health treatment. From a total of 132 participants who were initially approached for participation, 8 declined and 10 were excluded because they were illiterate or they received mental health treatment. Six more participants were excluded because although they were initially interviewed, the ICU stay of the patient was less than a week, due to patients’ death or transfer to another department. A total of 108 individuals participated in the study. Demographic information was obtained from participants and clinical information (APACHE score) was retrieved from patients’ charts.
Contaminated surfaces and air samples were only found in the direct surroundings of patients with a positive culture and never on other places on the ward. On seven occasions the outbreak strain was found on the hands of members of the hospital personnel, all of whom were caring for a patient known to be positive for the outbreak strain on that day. Since no other contaminated sites were found outside the direct environments of culture-positive patients, the most probable route of transmission is from patient to patient via the hands of personnel transiently contaminated with the organism. Edu- cating personnel on the proper application of hand disinfec- tants and making them more aware of the problem were suc- cessful, halting the epidemic in our institution.
Descriptive analyses included tabulation of basic descrip- tors (e.g., date), readability (e.g., legibility), the type of in- formation (e.g., patient history) and communication documented (e.g., provider-provider, provider-family). Two reviewers (KB, HK) independently coded all med- ical records to capture these quantitative items . Inter-rater reliability for nominal quantitative codes were evaluated on a random sample of 37 medical records (median kappa score 0.95, 95% confidence interval [CI] 0.96–0.99). Notes written during the ICU stay were compared to those written during the ward stay and be- tween medical and surgical patients using mixed-effects linear regression models accounting for patients clus- tered within hospitals. Results were summarized using means or mean percentages with 95% CIs. Analyses were done using Stata version 14 (StataCorp LP, College Station, TX, USA).
Patients with a reversible medical condition affecting one or more systems, that puts their life at severe risk, need special treatment in units that can monitor, surveil and provide the advanced vital support necessary to ensure patient recovery  In Chile in medical institutions of greater complexity, the care for those patients is organized in Critical Patient Units which provide intensivecare for critically ill patients (IntensiveCareUnit) and step-down facilities (High Dependency Unit)  . The IntensiveCareUnit is intended to provide permanent and timely care to unstable, critical patients; while stable patients are admitted to the High Dependency Unit for non-invasive monitoring, surveillance and continuous management . These units are classified according to their level of care. Level I (low) takes care of patients with organ dysfunction that requires continuous monitoring, and a minor need for pharmaceuticals and medical devices. Level II (medium) is intended for patients requiring higher pharmaceutical support and a greater need for medical devices in case of acute organ or system failure. Level III (high) units admit patients at risk or with two or more organs failing and those who require hemodynamic, renal or respiratory support .
delirium was 30%. Of 155 delirious patients, 75% were delir- ious on the first day of inclusion, and more than 90% after the third day. The incidence in the community hospitals was higher than the incidence in the private hospital or the university hos- pital. The mean age was 64 years and most of the population was male. The surgical and internal patients are equally repre- sented, but the participating hospitals showed some variety. Patients tended to stay longer in the intensivecareunit of the community hospital, but the length of stay in the intensivecareunit before inclusion was the same for all hospitals. More than 60% of the patients had an immediate inclusion in the study with regard to the protocol (24 hours after admission to the intensivecareunit). After 48 hours of admission to the inten- sive careunit, almost 80% of the population was included. Factors related to patient characteristics
Background: According to current evidence and psychological theorizing proper information giving seems to be a promising way to reduce patient anxiety. In the case of surgical patients, admission to the intensivecareunit (ICU) is strongly associated with uncertainty, unpredictability and anxiety for the patient. Thus, ICU specific information could have a high clinical impact. This study investigates the potential benefits of a specifically designed ICU-related information program for patients who undergo elective cardiac, abdominal or thoracic surgery and are scheduled for ICU stay.
We describe for the first time a case of macrophage activation syndrome (MAS) in a patient with a history of inflammatory myofibroblastic tumour (inflammatory pseudotumour, IPT) of the lung and thoracic spine. The patient was admitted to the intensivecareunit with a history of prolonged remitting fever, hepatosplenomegaly, bilaterally enlarged thoracic lymph nodes and an acute severe inflammatory response syndrome (SIRS). Up-regulated cytokine production (e.g. IL-1ß and IL-6), increased levels of ferritin and circulating soluble interleukin-2 receptor (sIL-2R, sCD25) led to the differential diagnosis of MAS. Bone marrow aspiration, the main tool for a definite diagnosis, revealed macrophages phagocytosing haematopoietic cells. Immunosuppressive therapy with corticosteroids and cyclosporine was an effective treatment in this patient.
Bed allocation in the critical careunit is specified by a pol- icy "Critical Care Directorate [CrCu] Resource Prioritisation" which addresses the ICU needs of the following institu- tional programs; Trauma, Surgical Oncology and Com- munity. This policy specifies priorities for intensivecareunit admission as follows: 1.) Intramural patients; any program affiliation, including war veterans from an adjoining chronic care facility, 2.) Extramural trauma referrals [as long as one intensivecareunit bed remains available] and surgical oncology patients (up to a maxi- mum of 2 occupied intensivecareunit beds per day), 3.)Extramural referrals including neurosurgical patients and other elective surgical patients requiring postopera- tive care in the intensivecareunit. The critical care physi- cian in charge is empowered by policy "VI-A-10 Admission of Acute Care Patients: Section 6 – Admission to a Critical CareUnit. Priority of Admission to a Critical CareUnit" as the sole participant making bed allocation decisions. Dis- putes or concerns about intensivecareunit bed allocation decisions, such as their potential to compromise patient safety due to inadequate resources are arbitrated by the Medical Director on Call whose authority to over-rule decisions is established by policy "Core PatientCare Policy: Patient Flow".
straightforward tool, building on the work of Mosenthal et al. in a trauma unit of having an approach suitable for all patients irrespective of prognosis , but formally integrating training, an initial assessment, and an ongoing log of communication. We found that PACE was accept- able and feasible for staff to use. The close working between palliative care and ICU staff in its development and imple- mentation led to sustained working. It was mainly com- pleted by nurses, which this is not unexpected, as other work has suggested the central role of nurses in ICU care . Results from the survey of relatives suggest that PACE improves symptom control, communication, and informa- tion provision. An examination of the qualitative responses shed light on these results; family members were apprecia- tive of the greater emphasis on communication and man- aging symptoms, which might have been supported in turn by a greater emphasis on support of the family members and of the patient’s individual needs.
Clinicians must focus on eliminating or minimizing the incidence of VAP through preventive techniques. Interventions to prevent pneumonia in the ICU should combine multiple measures targeting the invasive devices, microorganisms, and protection of the patient. VAP is particularly common in patients with ARDS, after tracheotomy, in patients with COPD, and in injured and burned patients. Careful monitoring, MiniBAL sample surveillance and implementation of VAP bundles are important in preventing and for early diagnosis of complications of mechanical ventilators. The microbial causes of VAP are many and varied. Most cases are caused by routine bacterial pathogens that reach the lung after aspiration of oropharyngeal secretions or direct inoculation into the airways. The causes of VAP and the likelihood of infection by an antibiotic-resistant strain can be predicted based on the patient characteristics, the duration of hospitalization, the duration of mechanical ventilation, prior exposure to antibiotic therapy, and prior colonization patterns. Local microbiology and antibiotic susceptibility data are essential for making informed antibiotic treatment choices. Simple and effective preventive measures can be instituted easily and at minimal costs. Such measures might include NIV, diligent respiratory care, hand hygiene, elevation of head, oral and not nasal cannulation, minimization of sedation, chest physiotherapy, prone positioning, the timing of tracheostomy, institution of weaning protocols, judicious use of antibiotics, de- escalation, and leveraging PK/PD characteristics for antibiotics administered. More costly interventions should be reserved for appropriate situations.
Findings: The barrier between autonomous nurses and doctors in the PICU within their silos of specialization, the failure of shared mental models, a culture of disrespect, and the lack of empowering parents as team members preclude interprofessional team management and patient safety. A mindset of individual responsibility and accountability embedded in a network of equivalent partners, including the patient and their family members, is required to achieve optimal interprofessional care. Second, working competently as an interprofessional team is a learning process. Working declared as a learning process, psychological safety, and speaking up are pivotal factors to learning in daily practice. Finally, changes in small steps at the level of the microlevel unit are the bases to improve interprofessional team management and patient safety. Once small things with potential impact can be changed in one’s own unit, engagement of health care professionals occurs and projects become accepted.
A Hospital based prospective and observational study and it was conducted in the Department of I.C.U and general medicine Medicine in Manipal Super Specialty Hospital, Vijayawada, India. During the period of the study (six months) July-Dec 2018, two hundred (200) patients were studied, who were admitted into the Department of Medicine as hepatic impairment cases. Their data was collected regularly from I.C.U and General Ward of Medicine, without interfering with their treatment. A specially designed proforma was used for collecting data which includes patient demographics, personal history, comorbidities, diagnosis and present medications